electrolyte imbalance and acid base disorders.

1. INTERPRETATION AND
CORRECTION OF ELECTROLYTE
ABNORMALITY
BY DR . ANKITA FRANCIS

2.  Fluid and electrolyte balance is a dynamic process.
 Plays an important role in homeostasis.
 Electrolyte in body fluids are active chemicals:-
1)Cations : Positive charge
2)Anions : Negative charge
 CATIONS: Sodium, Potassium, Magnesium and Hydrogen
ions
 ANIONS: Chloride, Bicarbonate ,Phosphate,Sulfate

3. FLUID VOLUME DISTURBANCES
 HYPOVOLEMIA – fluid volume deficit.
- can cause weakness, fatigue, fainting and
dizziness.
- caused by vomiting , diarrhoea and excessive
bleeding.
- can lead to shock.
 HYPERVOLEMIA – fluid volume excess.
- can cause weight gain, swelling and shortness of
breath.
- caused by heart, liver or kidney failure or high salt
diet ( water retention)

4. ELECTROLYTE IMBALANCE
 SODIUM DEFICIT – HYPONATREMIA
 SODIUM EXCESS – HYPERNATREMIA
 POTASSIUM DEFICIT – HYPOKALEMIA
 POTASSIUM EXCESS – HYPERKALEMIA
 CALCIUM DEFICIT – HYPOCALCEMIA
 CALCIUM EXCESS - HYPERCALCEMIA

5. HYPONATREMIA
 It results from loss of sodium containing fluids.
 It is serum sodium <135 mEq/L
 CAUSES:-
1)GI LOSS: diarrhoea, vomiting, Ng suction
2)RENAL LOSS: Diuretics, adrenal insufficiency, a renal
diseases
3)SKIN LOSS: Burns, wound drainage

6. MANAGEMENT
 Ringer Lactate(RL) solution (0.9% sodium chloride) is
prescribed
 Serum sodium must not increase greater than 12meq/L in 24
hours to avoid neurological damages.

7. HYPERNATREMIA
 Hypernatremia is a higher than normal sodium level
exceeding (145meq/L)
 CAUSES :-
1)Gain of sodium in excess of water
2)Inadequate water intake
3)Increased serum sodium conc.

8. MANAGEMENT
 Gradual lowering of the sodium level by the
infusion of a hypotonic electrolyte solution 0.3% sodium
chloride.
 Diuretics also may be prescribed to treat the sodium gain.

9. POTASSIUM IMBALANCE
 Potassium is major ICF cation, with 98% of the body
potassium being intracellular.
 Potassium is critical for many cellular and metabolic function.
 The kidneys are the primary route for potassium loss
 90% of daily potassium intake is eliminated by kidney.

10. HYPERKALEMIA
 It may be caused by a massive intake of potassium.
 CAUSES:
1)Excess potassium intake
- Excessive or rapid parenteral administration
- potassium containing drugs.
2)Shift of potassium out of cell
-acidosis, crush injury, tissue catabolism(fever)
3) Failure to eliminate potassium
-renal disease, adrenal insufficiency, ACE inhibitors

11. MANAGEMENT
 Immediate ECG Should be obtained
 Serum potassium level without IV fluid infusion
 Restriction of dietary potassium
 IV calcium gluconate administration if serum potassium
level is dangerously elevated (>6 mmol/L)

12. HYPOKALEMIA
 Hypokalemia can results from abnormal loss of potassium
from a shift of potassium from ECF to ICF or rarely from
deficient dietary potassium intake.
 CAUSES:-
1) Potassium loss
2) Shift of potassium into cells
3) Lack of potassium intake

13. MANAGEMENT
 It is treated with oral or IV replacement
 Administer 40 to 80 mEq / day of potassium
 When oral administration of potassium is not feasible, the IV
route is indicated
 For patient at risk for hypokalemia , diet containing potassium
should be provided.

14. CALCIUM IMBALANCE
 More than 99% of the body’s calcium is located in
skeletal system
 It is a major component of bone and teeth, about 1%
of skeletal calcium is exchanged with blood calcium.
 Calcium plays a major role in transmitting nerve
impulses and helps to regulate muscle contraction
and relaxation, including cardiac muscle.

15. HYPOCALCEMIA
 Any condition that causes a decreased production of PTH may
result in the development of hypocalcemia.
 CAUSES-
Multiple blood transfusion
Chronic renal failure
Elevated phosphorous
Chronic alcoholism
Alkalosis

17. MANAGEMENT
 IV Administration of calcium like:-
- calcium gluconate
- calcium chloride
- calcium gluceptate
 Vitamin D therapy be initiated to increase calcium absorption
from GI tract.
 Increasing the dietary intake of calcium to atleast 1,000 to
1,500mg/day.

18. HYPERCALCEMIA
 Hypercalcemia [excess of calcium in the plasma] is
dangerous imbalance when severe
 Hypercalcemia crisis has a mortality rate as high as
50% if not treated properly
 CAUSES:-
Multiple myeloma
Prolonged immobilization
Vit D over dose
Thiazide diuretics [slight elevation]

19. MANAGEMENT
 Administer fluids to dilute serum calcium and
promote its excretion by the kidney.
 IV administration of 0.9% sodium chloride solution
temporarily dilutes the serum calcium level.
 Administering furosemide increases calcium
excretion.
 Calcitonin is administered to lower the serum calcium
level.

20. ACID – BASE IMBALANCE
 Acidity or alkalinity of a solution is determined by its
concentration of hydrogen ions (h+).
 The unit used to describe acid base is pH
 The pH scale ranges from 0-14. Neutral pH is 7 ,
Acidic PH- <7,Basic Ph- >7
 Normal blood plasma is slightly alkaline and has a
normal pH range of 7.35-7.45

21.  ACIDOSIS
 It is the condition characterized by an excess of H ions or loss
of base ions/bicarbonate in ECF in which the PH falls below
7.35
 ALKALOSIS
 It occurs when there is a lack of H ions or a gain of base and
the PH exceeds 7.45

22. ACID BASE REGULATION
 Normally the body has three mechanisms by which it
regulates acid-base balance to maintain the arterial
ph .
 BUFFER SYSTEM - reacts immediately
 THE RESPIRATORY SYSTEM - responds in minutes
and reaches maximum effectiveness in hours
 THE RENAL SYSTEM - takes 2-3 days to responds
maximally

23. CLASSIFICATION
 Acid-base imbalances are classified as:-
RESPIRATORY IMBALANCE - Affects carbonic acid conc.
- 2 types:-
1)Respiratory acidosis
2)Respiratory alkalosis
METABOLIC IMBALANCE – Affects the base bicarbonate.
- 2 types:-
1)Metabolic acidosis
2)Metabolic alkalosis

24. RESPIRATORY ACIDOSIS
 Respiratory acidosis is a clinical disorder in which the pH is
less than 7.35 and the PaCo2 is greater than 42mmHg
 CAUSES
Elevated plasma level
Elevated carbonic acid
Acute pulmonary edema
Atelectasis
Impaired respiratory muscles

25. CLINICAL MANIFESTATIONS
 Increased pulse
 Increased respiratory rate
 Increased blood pressure
 Mental cloudiness
 Increased intra cranial pressure
 Feeling of fullness in head

26. MANAGEMENT
 Treatment is directed by improving ventilation.
 Pharmacologic agent
 bronchodilators
 antibiotic
 anti coagulants
 Pulmonary hygiene measures
 adequate hydration
 mechanical ventilation

27. RESPIRATORY ALKALOSIS
 Respiratory alkalosis is a clinical condition in which the arterial pH is
greater than 7.45 and the paco2 is less than 38mmhg.
 CAUSES:-
1)Respiratory alkalosis is always due to hyperventilation
2) Anxiety
3) Hypoxemia
4) Chronic hypocapnia
5)Decreased serum bicarbonate levels
6)Chronic hepatic insufficiency and cerebral tumors

28. CLINICAL MANIFESTATIONS
 Light headedness due to vasoconstriction
 Decreased cerebral flow
 Numbness
 Loss of consciousness
 Tachycardia

29. MANAGEMENT
 Treatment depends on the underlying cause respiratory
alkalosis
 Anxiety : patient is instructed to breath more slowly to allow
co2 to accumulate
 Sedative may be required to relieve hyperventilation in very
anxious patients.

30. METABOLIC ACIDOSIS
 Metabolic acidosis is a clinical disturbance characterized by a
low pH (increased hydrogen ions)and a low plasma
bicarbonate concentration.
 It can be produced by a gain of hydrogen ions or a loss of
bicarbonate

31. CLINICAL MANIFESTATIONS
 Headache
 Confusion
 Drowsiness
 Increased respiratory rate depth
 Nausea and vomiting
 Decreased blood pressure
 Cold and clammy skin
 Dysrhythmias
 Shock

32. DIAGNOSIS AND MANAGEMENT
 Arterial blood gas analysis:-
- low bicarbonate level(less than 22 mEq/l)
- Low pH (less than 7.35)
 ECG will detect dysrhythmias caused by increased potassium.
 MANAGEMENT:-
If problem results from excessive intake of chloride, treatment
is aimed at eliminating the source of chloride.
Bicarbonate is administered if the pH is less than 7.1
Serum potassium level is monitored closely and hypokalemia
is corrected.

33. METABOLIC ALKALOSIS
 Metabolic alkalosis is a clinical disturbance characterized by a high pH
(decreased H⁺ ions concentration) and a high plasma bicarbonate concentration.
It can be produced by a gain of bicarbonate or a loss of H⁺ ions.
 CAUSES:-
-Vomiting
- Gastric suction
- Diuretic therapy that promotes excretion of Potassium
- Chronic ingestion of milk and calcium carbonate

34. MANIFESTATIONS AND MANAGEMENT
 Tingling of the fingers and toes
 Dizziness
 Ventricular disturbances (pH increase above 7.6)
- MANAGEMENT:-
- Sufficient chloride must be supplied for kidney to absorb
sodium with chloride.
- Administering sodium chloride fluids.
- Input and output should be monitored.

35. THANK YOU